Provider Demographics
NPI:1346510179
Name:CARMENATE, ELIADES JESUS (MD)
Entity Type:Individual
Prefix:
First Name:ELIADES
Middle Name:JESUS
Last Name:CARMENATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 BISCAYNE BLVD STE 321
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3202
Mailing Address - Country:US
Mailing Address - Phone:786-536-2003
Mailing Address - Fax:800-536-1148
Practice Address - Street 1:4770 BISCAYNE BLVD STE 1450
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3237
Practice Address - Country:US
Practice Address - Phone:786-536-2003
Practice Address - Fax:800-536-1148
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 117443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009702800Medicaid
FLHS208ZOtherMEDICARE